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Tornado Tabletop ExerciseTornado Tabletop Exercise
Photo courtesy of NOAA Photo Library
Minnesota Emergency Readiness Education and Training Program
(MERET)
MERET worked with partners in Minnesota to adapt curriculum to support the Hospital Incident Command System (HICS) training
MERET is a program designed to educate and train Minnesota’s health care workers in emergency preparedness, tailoring efforts to the unique needs of specific communities as they prepare for a health emergency or bioterrorism event. MERET is funded by the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the U.S. Department of Health and Human Services, and is administered by the University of Minnesota Schools of Nursing and Public Health. Carol O’Boyle, PhD, RN, at the School of Nursing, is the Principal Investigator.
Minnesota Emergency Readiness Education and Training (MERET) is funded under grant #TO1HP06412 from the Office of the Assistant Secretary for Preparedness and Response (ASPR),DHHS, Bioterrorism Training and Curriculum Development Program.
Tabletop ObjectivesTabletop Objectives
Using a tornado scenarioUsing a tornado scenario::●● Demonstrate understanding and skill in opening an Incident Demonstrate understanding and skill in opening an Incident
Command PostCommand Post● ● Activate appropriate modules within the Incident Command Activate appropriate modules within the Incident Command
SystemSystem● ● Demonstrate ability to perform roles and responsibilitiesDemonstrate ability to perform roles and responsibilities● ● Demonstrate ability to locate and implement Job Action Demonstrate ability to locate and implement Job Action
Sheets (JAS)Sheets (JAS)● ● Verbalize understanding of a coordinated emergency Verbalize understanding of a coordinated emergency
response with other community agenciesresponse with other community agencies● ● Assess needs for alternative modes of operation. Assess needs for alternative modes of operation. ● ● Verbalize importance of contributing to team efforts Verbalize importance of contributing to team efforts ● ● Verbalize understanding of continuity of operationsVerbalize understanding of continuity of operations
Background InformationBackground Information
Sunday afternoon NWS Sunday afternoon NWS issues issues Tornado WatchTornado Watch (insert general area e.g. (insert general area e.g. SW and SC) MinnesotaSW and SC) Minnesota
At 4:40 PM National At 4:40 PM National Weather Service issues Weather Service issues Special Weather Special Weather StatementStatement of a line of of a line of severe storms developing severe storms developing over (insert general area over (insert general area e.g. SW and SC) e.g. SW and SC) MinnesotaMinnesota
Photo courtesy of NOAA Photo Library
Are we doing anything with Are we doing anything with this information for the this information for the
organization?organization?
Background InformationBackground Information At 5:45 PM NWS issues At 5:45 PM NWS issues
a a Severe Thunderstorm Severe Thunderstorm WarningWarning for( insert for( insert general area e.g. Brown general area e.g. Brown and Watonwan) and Watonwan) CountiesCounties
NWS radar indicates a NWS radar indicates a line severe line severe thunderstorms between thunderstorms between (insert general (insert general information e.g. Sleepy information e.g. Sleepy Eye and St. James) Eye and St. James) moving eastmoving east
Photographer: D. Burgess. Photo courtesy of NOAA Photo Library
Would we do anything Would we do anything with this new with this new information?information?
Emergencies Present In 2 Emergencies Present In 2 Ways…Ways…
Oklahoma City Bombing
Tornado
Hurricane Katrina
Midwest Floods
Pandemic FluNorthridge Earthquake
The Amount of Time We’re GivenTo Pre-Organize People and Pre-Stage Equipment
Can Drastically Change Our Response Effectiveness
Anticipatedand/or
With Warning
Anticipatedand/or
With Warning
Unanticipatedand/or
Without Warning
Unanticipatedand/or
Without Warning
Illustration courtesy of Pete Brewster – VA Medical System
Incident progressionIncident progression
BOOM!
Reactive PhaseRecognitionNotificationsInitial control and safety actionsEstablish ICP
Primary ToolsSOPsJob Action Sheets
Primary GoalPrevent incident expansionPrevent responder injury
Proactive PhaseSituation assessedObjectives establishedStrategies / tacticsResources requested
Primary ToolsICSIncident Action Planning
Primary GoalManage incident
Slide courtesy of John Hick Hennepin County Medical Center
What are the respective agencies What are the respective agencies doing with this Tornado Warning?doing with this Tornado Warning?
FireFire Law EnforcementLaw Enforcement EMS/AmbulanceEMS/Ambulance Emergency Management Emergency Management HospitalHospital
Establish an Incident Command Establish an Incident Command Center/PostCenter/Post
Where will it be located? Is there a back-Where will it be located? Is there a back-up location in case of destructionup location in case of destruction
Determine positions to be openedDetermine positions to be opened Hand out Job Action Sheets (JAS)Hand out Job Action Sheets (JAS) Put on job vestsPut on job vests Begin FormsBegin Forms
Forms 201 Incident BriefingForms 201 Incident Briefing Forms 202 Incident ObjectivesForms 202 Incident Objectives
Prepare/Practice/AnticipatePrepare/Practice/Anticipate
Scenario DevelopmentScenario Development
At 6:10 PM NWS issues a At 6:10 PM NWS issues a Tornado WarningTornado Warning for for (insert local info e.g.Blue (insert local info e.g.Blue Earth and Nicollet) Earth and Nicollet) Counties until 7:00 PMCounties until 7:00 PM
At 6:15 PM weather At 6:15 PM weather spotter confirms tornado spotter confirms tornado on the ground (insert on the ground (insert local info e.g.NE of Lake local info e.g.NE of Lake Crystal on HWY 60) Crystal on HWY 60) moving NE at 30 MPHmoving NE at 30 MPH
Photo courtesy of NOAA Photo Library
How do we respond to How do we respond to this NWS this NWS Tornado Tornado
Warning?Warning?
Scenario DevelopmentScenario Development
At 6:20 PM sheriff deputies At 6:20 PM sheriff deputies report tornado touchdown report tornado touchdown just west of (add local info just west of (add local info e.g.Mankato near e.g.Mankato near Minneopa Park)Minneopa Park)
At 6:30 PM local police At 6:30 PM local police notify dispatch of tornado notify dispatch of tornado on the ground in the cityon the ground in the city
At 6:35 PM power blinks At 6:35 PM power blinks off/on at Hospital facilityoff/on at Hospital facility
At 6:37 PM Tornado hits At 6:37 PM Tornado hits Hospital facilityHospital facility
Photo courtesy of NOAA Photo Library
Job Action Sheets (JAS)Job Action Sheets (JAS)1. Title1. Title2. Purpose2. Purpose3. To3. To whom they whom they reportreport4. Critical action 4. Critical action considerationsconsiderations5. Forms required by 5. Forms required by
the jobthe job6. Broken into 6. Broken into operational periodsoperational periods
JAS JAS “prompts” the team “prompts” the team member to take needed member to take needed actions related to their actions related to their roles and responsibilitiesroles and responsibilities
Courtesy of HICS
HICS 201 Form (Incident HICS 201 Form (Incident Briefing)Briefing)
1. Incident Name,2. Date of Briefing3. Time of Briefing4. Event History 5. Current Actions 6. Summary7. Current Organization8. Notes (Accomplishments, Issues, Directives)9. Name of the individual who prepared the document10. Facility Name
Courtesy of HICS
Scenario DevelopmentScenario Development
Tornado hits south and Tornado hits south and west sides of buildingwest sides of building
Roof is off on the 5200 Roof is off on the 5200 and 5400 wingsand 5400 wings
Windows are broken on Windows are broken on the 5200 and 5400 the 5200 and 5400 wings on ALL floorswings on ALL floors
Tornado lasts about 10 Tornado lasts about 10 minutes with severe minutes with severe winds and heavy winds and heavy rainfallrainfall
Photo courtesy Mark Wolfe/FEMA
Tornado ImplicationsTornado Implications
Main power has been Main power has been interrupted – on interrupted – on generatorgenerator
Phone system outside Phone system outside the hospital is disabledthe hospital is disabled
Cell phone towers are Cell phone towers are down down
Major damage reported Major damage reported (via AM radio) (via AM radio) throughout the throughout the City/CountyCity/County
Photo courtesy Marvin Nauman/FEMA
Facility System Status ReportFacility System Status Report
1. Operational Period Date/Time
2. Date Prepared3. Time Prepared4. Building Name5. System Status Checklist
IT system Communication System Infrastructure Patient Care System Security System Utilities, External
System Utilities, Internal
System6. Certifying Officer7. Facility Name
Courtesy of HICS
Scenario DevelopmentScenario Development What are you going to What are you going to
do?do? What are our priorities?What are our priorities? Incident CommandIncident Command
Who is in charge?Who is in charge? What resources do we What resources do we
have?have? How to access more How to access more
resources?resources? Communication?Communication? Infrastructure Infrastructure
assessment?assessment? Evacuation/Off-site Evacuation/Off-site
care?care?
Photo courtesy of Mike Branick
Managing by Objectives Managing by Objectives Incident Action Plan (IAP)Incident Action Plan (IAP)
There is only one Incident Action Plan at an incident There is only one Incident Action Plan at an incident which identifieswhich identifies
WHAT must be done?WHAT must be done? WHO is responsible?WHO is responsible? How information will be COMMUNICATED?How information will be COMMUNICATED? What if a responder is INJURED?What if a responder is INJURED?
Overall Priorities Overall Priorities Life SavingLife Saving Incident stabilizationIncident stabilization Property PreservationProperty Preservation
Establish Incident Action Plan objectives, strategies, Establish Incident Action Plan objectives, strategies, tacticstactics
Slide courtesy of FEMA
Establishment of Incident Establishment of Incident Objectives and StrategyObjectives and Strategy
What are the Strategic Goals?What are the Strategic Goals?
What are the immediate Tactical What are the immediate Tactical Objectives?Objectives?
Remember – Documentation!Remember – Documentation!
HICS 202 Form (Incident HICS 202 Form (Incident Objectives)Objectives)
1. Incident name
2. Date prepared
3. Time prepared
4. Operational period ( date & time)
5. General command & control objectives for the incident (including alternatives)
6. Weather/environmental implications during the period (forecast, wind speed/direction, daylight)
7. General safety/staff messages to be given
8. Attachments (ex. medical plan, facility system status)
9. Name of the individual who prepared the document
10. Approval of the Incident Commander
11. Facility nameCourtesy of HICS
Incident Action Plan Establishes Incident Action Plan Establishes Objectives, Strategies, and TacticsObjectives, Strategies, and Tactics
State what will be accomplished (agency exec and State what will be accomplished (agency exec and IC)IC)
Establish the general plan or Establish the general plan or direction for accomplishing the direction for accomplishing the incident objectives (IC)incident objectives (IC)
Tactics Specify how the strategies will Specify how the strategies will
be executed. (be executed. (OperationsOperations))
Incident Objectives
Strategies
Slide courtesy of FEMA
Incident Command StaffIncident Command Staff How much of the ICS is How much of the ICS is
implemented?implemented? Staff in the ICS organizational Staff in the ICS organizational
structure are appointed as the structure are appointed as the incident complexity expandsincident complexity expands
SafetyOfficerSafetyOfficer
LiaisonOfficerLiaisonOfficer
Public InformationOfficer
Public InformationOfficer
Command Staff
IncidentCommander
IncidentCommander
OperationsSection
OperationsSection
PlanningSection
PlanningSection
LogisticsSection
LogisticsSection
Finance/AdminSection
Finance/AdminSection
General Staff
Slide courtesy of FEMA
Sample “Build Outs”: Sample “Build Outs”: ImmediateImmediate
Incident Commander
PlanningSection Chief
LogisticsSection Chief
Operations Section Chief
Finance/Administration Section Chief
LiaisonOfficer
Medical/Technical Specialist
SafetyOfficer
Public Information
Officer
ProcurementUnit Leader
Compensation/Claims
Unit Leader
TimeUnit Leader
CostUnit Leader
ServiceBranch Director
SupportBranch Director
ResourcesUnit Leader
SituationUnit Leader
Documentation Unit Leader
Demobilization Unit Leader
Staging Manager
Medical Care Branch Director
Infrastructure Branch Director
HazMatBranch Director
SecurityBranch Director
Business Continuity
Branch Director
Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit
Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit
Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit
Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit
Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit
PersonnelVehicleEquipment/SupplyMedication Personnel Tracking
Materiel Tracking
Patient TrackingBed Tracking
Communications UnitIT/IS UnitStaff Food & Water Unit
Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit
Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist
Legend
Activated Position
LogisticsSection Chief
ProcurementUnit Leader
Compensation/Claims
Unit Leader
TimeUnit Leader
CostUnit Leader
ServiceBranch Director
SupportBranch Director
Slide courtesy of FEMA
CommunicationsCommunications What do you communicate to the community?What do you communicate to the community? Who is the spokesperson?Who is the spokesperson? What is the plan for news media?What is the plan for news media? Who will be the Public Information Officer?Who will be the Public Information Officer? Is there a Joint Public Information Center?Is there a Joint Public Information Center? Will a press conference be scheduled?Will a press conference be scheduled? What are the key messages?What are the key messages? When/How will updates be When/How will updates be
done?done?
Photo courtesy of FEMA Photographer Mike Howard
Scenario MessagesScenario Messages
Incident CommandIncident Command Public Information Public Information
Officer (PIO)Officer (PIO) OperationsOperations Emergency Emergency
DepartmentDepartment SafetySafety
LogisticsLogistics PlanningPlanning FinanceFinance Medical Medical
Director/PhysicianDirector/Physician NursingNursing Infection ControlInfection Control
How much of HEICS is How much of HEICS is implemented…implemented…
OPERATIONS PLANNING
LOGISTICS FINANCE
COMMAND
Images courtesy of USA.gov
Future Objectives & StrategiesFuture Objectives & Strategies
Where might we relocate Where might we relocate other essential functions?other essential functions?
How do you sustain How do you sustain prolonged incident like prolonged incident like this while your facility is this while your facility is stabilized to resume care stabilized to resume care and treatment for your and treatment for your community (5-7 days)community (5-7 days)
What do you What do you communicate to the communicate to the community?community?
Sample “Build Outs”: Sample “Build Outs”: ExtendedExtendedIncident Commander
PlanningSection Chief
LogisticsSection Chief
Operations Section Chief
Finance/Administration Section Chief
LiaisonOfficer
Medical/Technical Specialist
SafetyOfficer
Public Information
Officer
ProcurementUnit Leader
Compensation/Claims
Unit Leader
TimeUnit Leader
CostUnit Leader
ServiceBranch Director
SupportBranch Director
ResourcesUnit Leader
SituationUnit Leader
Documentation Unit Leader
Demobilization Unit Leader
Staging Manager
Medical Care Branch Director
Infrastructure Branch Director
HazMatBranch Director
SecurityBranch Director
Business Continuity
Branch Director
Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit
Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit
Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit
Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit
Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit
PersonnelVehicleEquipment/SupplyMedication Personnel Tracking
Materiel Tracking
Patient TrackingBed Tracking
Communications UnitIT/IS UnitStaff Food & Water Unit
Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit
Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist
Legend
Activated Position
LogisticsSection Chief
ProcurementUnit Leader
Compensation/Claims
Unit Leader
TimeUnit Leader
CostUnit Leader
ServiceBranch Director
SupportBranch Director
Slide courtesy of FEMA
Schedule for Operations briefingSchedule for Operations briefing
Planning Section ChiefPlanning Section Chief reviews agenda and facilitates reviews agenda and facilitates
▼▼ IC presents objectives (sometimes defers to Planning Chief to present)IC presents objectives (sometimes defers to Planning Chief to present)
▼▼ Off-going Operations Section Chief – provides current assessment and Off-going Operations Section Chief – provides current assessment and
accomplishments during last ops periodaccomplishments during last ops period▼▼
Oncoming Operations Section Chief – covers work assignments and Oncoming Operations Section Chief – covers work assignments and staffingstaffing▼▼
Technical Specialist -Safety Officer – Special Operations –present updatesTechnical Specialist -Safety Officer – Special Operations –present updates▼▼
May have specific Unit Leaders present informationMay have specific Unit Leaders present information▼▼
Final IC commentsFinal IC comments▼▼
Planning Section Chief announces next briefing time/location, adjournPlanning Section Chief announces next briefing time/location, adjourn
Slide courtesy of FEMA
PlanningMeetingDevelop
strategies &tactics to
Accomplishobjectives
ImplementAction Plan
Assess progressusing measuresof effectiveness
ManagementMeeting
Evaluates& revisesincident
objectives
OperationsBriefingBriefs the
operationalleaders on the
Action Plan
Action Planpreparation& approval
Incident ManagerSets overall
incident objectives& priorities
On-goingsituation
assessment& information
processing
Incident isrecognized
Notifications,assessment,Immediate
needsare
addressed
United States Coast Guard
Next Steps/Follow-UpNext Steps/Follow-Up
Are their any large gaps that are Are their any large gaps that are identified?identified?
What can be done to close those gaps?What can be done to close those gaps? Who is responsible?Who is responsible? What is the timeline?What is the timeline?
Sample “Build Outs”Sample “Build Outs”Incident Commander
PlanningSection Chief
LogisticsSection Chief
Operations Section Chief
Finance/Administration Section Chief
LiaisonOfficer
Medical/Technical Specialist
SafetyOfficer
Public Information
Officer
ProcurementUnit Leader
Compensation/Claims
Unit Leader
TimeUnit Leader
CostUnit Leader
ServiceBranch Director
SupportBranch Director
ResourcesUnit Leader
SituationUnit Leader
Documentation Unit Leader
Demobilization Unit Leader
Staging Manager
Medical Care Branch Director
Infrastructure Branch Director
HazMatBranch Director
SecurityBranch Director
Business Continuity
Branch Director
Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit
Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit
Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit
Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit
Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit
PersonnelVehicleEquipment/SupplyMedication Personnel Tracking
Materiel Tracking
Patient TrackingBed Tracking
Communications UnitIT/IS UnitStaff Food & Water Unit
Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit
Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist
Legend
Activated Position
LogisticsSection Chief
ProcurementUnit Leader
Compensation/Claims
Unit Leader
TimeUnit Leader
CostUnit Leader
ServiceBranch Director
SupportBranch Director
Incident Commander
PlanningSection Chief
LogisticsSection Chief
Operations Section Chief
Finance/Administration Section Chief
LiaisonOfficer
Medical/Technical Specialist
SafetyOfficer
Public Information
Officer
ProcurementUnit Leader
Compensation/Claims
Unit Leader
TimeUnit Leader
CostUnit Leader
ServiceBranch Director
SupportBranch Director
ResourcesUnit Leader
SituationUnit Leader
Documentation Unit Leader
Demobilization Unit Leader
Staging Manager
Medical Care Branch Director
Infrastructure Branch Director
HazMatBranch Director
SecurityBranch Director
Business Continuity
Branch Director
Power/Lighting UnitWater/Sewer UnitHVAC UnitBuilding/Grounds Damage UnitMedical Gases UnitMedical Devices UnitEnvironmental Services UnitFood Services Unit
Inpatient UnitOutpatient UnitCasualty Care UnitMental Health UnitClinical Support Services UnitPatient Registration Unit
Detection and Monitoring UnitSpill Response UnitVictim Decontamination UnitFacility/Equipment Decontamination Unit
Access Control UnitCrowd Control UnitTraffic Control UnitSearch UnitLaw Enforcement Interface Unit
Information Technology UnitService Continuity UnitRecords Preservation UnitBusiness Function Relocation Unit
PersonnelVehicleEquipment/SupplyMedication Personnel Tracking
Materiel Tracking
Patient TrackingBed Tracking
Communications UnitIT/IS UnitStaff Food & Water Unit
Employee Health & Well-Being UnitFamily Care UnitSupply UnitFacilities UnitTransportation UnitLabor Pool & Credentialing Unit
Biological/Infectious DiseaseChemicalRadiologicalClinic AdministrationHospital AdministrationLegal AffairsRisk ManagementMedical StaffPediatric CareMedical Ethicist
Legend
Activated Position
LogisticsSection Chief
ProcurementUnit Leader
Compensation/Claims
Unit Leader
TimeUnit Leader
CostUnit Leader
ServiceBranch Director
SupportBranch Director
Immediate Extended
Slide courtesy of FEMA
THE END!THE END!
Thanks for ParticipatingThanks for Participating
MERET Acknowledges its Partners:
1. Healthcare System Preparedness Program Partnersa. Minnesota Department of Health–Office of Emergency
Preparednessb. MDH Metropolitan Hospital Compactc. Regional Hospital Resource Center Focus Group:
• Michelle Allen, Northwest• Clyde Annala, Northeast• Jill Burmeister, South Central• Chuck Hartsfield, Central• Marla Kendig, Southeast• Emily Parsons, MDH-OEP• Justin Taves, West Central• Eric Weller, South Central
2. FEMA Independent Study Program
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